What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior?
Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)

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Saturday, March 17, 2007

A Doctor’s Free Speech: When is It Unprofessional?

Medpundit today has brought to the visitors attention an article in the Detroit Free Press Freep.com website titled “Is Dr. Blogger telling too much?” It deals with the blogger physicians getting close to not abiding with the federal government’s Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding patient confidentiality or emptying crude and graphic descriptions of patients onto their visitors. This all might be called “free speech” but we must decide whether it is beneficial for the public to read that stuff. Is it good to have blogger physicians tell the public exactly what they think and feel about their patients so we can all see that they are human and can have concerns, biases or wild thoughts about their patients. Or on the other hand should these expressions of the physician’s thoughts be considered bad and unprofessional, actually hurting the entire medical profession? Read the story in both Medpundit and Freep.com and then tell us here what you think. ..Maurice.

6 Comments:

In the earlier days, physicians were considered to be flawless - an image that has deteriorated with the unfortunate proliferation of sue-happy families and lawyers. Giving a human face to medicine and letting anyone see that physicians are people, too, can only assist in creating a new image - a physician who is so selfless that even though they might find you disgusting or inappropriate or morally reprehensible, they will still put their future on the line by treating you to the best of their ability.

But do you think that showing the public that we in medicine have a "human face" and that we are "people" is more beneficent to the patients than the goal of physicians to strive to think and therefore behave more professionally? Wouldn't it be a goal that physicians should make an effort to be and show more openness to patient information, less bias, more understanding and less criticism of patient behavior and make attempts to suppress and not broadcast wild patient descriptions? In other words, show that because of the privileges and responsibilities society has given our profession, as physicians we are trying to be "better" than the average human. I can't say for sure that we can accomplish this goal, but my question would be, if it were possible, for the benefit of the patient, shouldn't we try? ..Maurice.

If there could be a return to the great utopian ideal, I think it would be excellent. But I just don't think it's possible, and maybe flipping the ideal on its head would be more appropriate now.

By showing that physicians are indeed flawed, but they operate at the behest of humanity and sacrifice themselves despite their flaws, it almost creates a new standard. I think it's a good idea to give patients some motivation to improve themselves and make their physician want to respect them.

Dr. Bernstein, from a patient's perspective - one who frequents the medical blogosphere - I have to say that Doc bloggers, even those with an attitude, are more helpful than harmful to the physician/patient relationship.

When we can witness a physician's negative response to particular patients, or circumstances, it reminds us that we have a responsibility in the relationship - and that physicians are human beings ... each one of them an individual, with his/her own likes, dislikes, hangups, reactions ... etc.

Having one half of the people in a two person relationship harbor unrealistic expectations, fail to walk in reality, and generally fall short of recognizing that the person they're dealing with is a fellow human being, is not productive - or healthy - to any relationship.

It seems to me that in the past, "professional" has been vaguely-defined. I think that a more universal and concrete description of what it means to be a professional is in order. Otherwise, everyone who responds to this query will be coming from their own unique definition.

It also appears to me that for doctors (I am a nurse), the definition of "professional" has always included some secrecy, some holding back from the patient. And I have never understood why that should fit into the definition. Mental health professionals say that secrecy in a family is actually a dysfunctional thing. So why do we think it is a GOOD thing in the medical profession?

The opposite of secrecy is information-sharing. The blogspot mentioned in the Detroit Free Press shared information, as do some of the other medical blogs. Examples of real patients (with identifying details masked) are used to clarify certain points that are made. I, for one, am okay with that. In fact, I like it much more than the secrecy and inner-sanctum and the I-know-more-than-you-know air of some doctors.

I predict that doctors will or already have "lost their innocence" via the medical blogs. And, HUZZAH!, they may also lose their arrogance!Chris and Vic

Chris and Vic, I have never felt or understood nor do we teach students that there is an element of secrecy in the term or being a professional. Of course, in the distant magical days of caring for the sick, I am sure that there was secrecy in the guild of healers. Probably there is likewise in this modern age in some cultures such secrecy still pervades those healers too.

If present day physicians have an air of secrecy about them, it is that still with all the medical knowledge broadcasting on TV or the internet, there still are many highly detailed technical aspects of medical care which are still unknown to the general public and if physicians don't take time to explain pertinent technical facts to their patients or take the time or the clarity to explain answers to the patient's questions, patients may assume that the doctor is trying to hold something back from them.And I am sure that is where the secrecy issue appears. Otherwise, the business and legal aspects of medicine are well publicized and should hold no secrets.

One other aspect of secrecy should be noted here. Some cultures insist that the patient not be informed about the details and prognosis of their illnesses. These orders are often given by relatives or members of a cultural community. These orders are particularly uncomfortable for physicians in the United States to follow since informed consent is an essential component of the ethics and law of medicine here...Maurice.

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